Document Detail


Prevention of neointimal hyperplasia associated with modified stretch expanded polytetrafluoroethylene hemodialysis grafts (Gore) in an experimental preclinical study in swine.
MedLine Citation:
PMID:  21944911     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Stenosis is the main cause of hemodialysis vascular graft failure and it is primarily caused by neointimal hyperplasia (NH) development at the vein-graft anastomosis. Even though NH development factors are well known, their activation pathway still remains disputed and the real role of the mismatch compliance between the vein and the graft wall has not yet been resolved. The purpose of this experimental study in swine was to verify the possibility of preventing the development of NH at the vein-graft anastomosis using a modified commercially available longitudinal stretch expanded polytetrafluoroethylene (ePTFE) Gore (W. L. Gore & Associates, Flagstaff, Ariz) graft (either standard or heparin-bonded) with an added handmade ePTFE radial stretch cuff at one end to reduce the compliance between the graft and the vein wall.
METHODS: Twelve ePTFE stretch grafts (6 modified and 6 unmodified) were surgically placed as arterovenous grafts (AVGs) between the carotid artery and the external jugular vein in 6 pigs. In each pig, one modified graft was placed on one side and one corresponding unmodified graft on the other side as a control. In 4 pigs, standard stretch ePTFE Gore grafts were used, and in 2 pigs, heparin-bonded stretch Gore grafts were used; 2 pigs were also treated with antiplatelet drugs. All the implanted grafts had a total length of 8 cm and a diameter of 6 mm. The modified graft was realized by cutting a short segment of the commercially available graft lengthwise which was then sewn crosswise (rotated 90°) with the same diameter as the original graft and was then added to it. A Doppler ultrasound scan was used for monitoring the graft patency immediately, weekly, and before death. At death (21-28 days after implantation), artery, vein, and graft specimens were collected "en bloc" for histopathology.
RESULTS: The modified grafts in the antiplatelet-treated animals were able to completely prevent NH development on vein wall (100% in 2 subjects) which was also reduced in antiplatelet untreated animals (66.5%, 96.4%, and 100% in 3 subjects, respectively). The modified standard stretch grafts and similarly modified heparin-bonded stretch grafts obtained the same good results in NH prevention.
CONCLUSION: Data provide evidence of the efficacy of modified stretch ePTFE grafts with an added radial stretch cuff for the prevention of NH in swine models and support the hypothesis of the pivotal role of mismatch compliance between the graft and the vein wall in NH development.
Authors:
Massimiliano Gessaroli; Cristiano Bombardi; Massimo Giunti; Maria Laura Bacci
Publication Detail:
Type:  Journal Article     Date:  2011-09-23
Journal Detail:
Title:  Journal of vascular surgery     Volume:  55     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-20     Completed Date:  2012-02-02     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  192-202     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Vascular and Endovascular Surgery Unit, Infermi Hospital, Rimini, Italy. maxgessaroli53@libero.it
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MeSH Terms
Descriptor/Qualifier:
Animals
Arteriovenous Shunt, Surgical / adverse effects,  instrumentation*
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation / adverse effects,  instrumentation*
Carotid Arteries / surgery*
Compliance
Constriction, Pathologic
Female
Graft Occlusion, Vascular / etiology,  pathology,  physiopathology,  prevention & control*
Hyperplasia
Jugular Veins / pathology,  physiopathology,  surgery
Male
Materials Testing
Models, Animal
Platelet Aggregation Inhibitors / pharmacology
Polytetrafluoroethylene*
Prosthesis Design
Renal Dialysis*
Swine
Time Factors
Tunica Intima / pathology*
Ultrasonography, Doppler
Vascular Patency
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 9002-84-0/Polytetrafluoroethylene

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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